Healthcare Provider Details

I. General information

NPI: 1821922824
Provider Name (Legal Business Name): JUSTEEN JACKSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 W MESQUITE BLVD STE 113
MESQUITE NV
89027-4774
US

IV. Provider business mailing address

12 W MESQUITE BLVD STE 113
MESQUITE NV
89027-4774
US

V. Phone/Fax

Practice location:
  • Phone: 702-346-4883
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number882973
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: